=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740389329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHANG ADVANCED CHIROPRACTIC P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 04/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7004-C LITTLE RIVER TURNPIKE
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-916-0303
-----------------------------------------------------
Fax | 703-658-4881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7004-C LITTLE RIVER TURNPIKE
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-916-0303
-----------------------------------------------------
Fax | 703-658-4881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KI WON CHANG
-----------------------------------------------------
Credential | D.C. FIAMA.
-----------------------------------------------------
Telephone | 703-916-0303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104556321
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104556012
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------